Cervical Cancer

Regimen Options

Last Updated: 02/07/2025 See Details

NOTE: FOR BEVACIZUMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
EARLY (STAGE IA2-IB1); LOCALLY ADVANCED (STAGE 1B2-IVA) NON-METASTATIC
Chemoradiation	cisplatin or carboplatin (if cisplatin intolerant)	Low	High	NCCN Guidelines® for Cervical Cancer V.1.2017. Keys HM, et al. N Engl J Med. 1999;340(15):1154-61. Rose PG, et al. J Clin Oncol. 2007;25(19):2804-10.
	cisplatin and pembrolizumab FIGO 2014 Stage III–IVA	Low	High	NCCN Guidelines® for Cervical Cancer V.2.2025. Lorusso, Domenica et al. The Lancet, Volume 403, Issue 10434, 1341 - 1350
	carboplatin and pembrolizumab (if cisplatin intolerant) FIGO 2014 Stage III–IVA	Low	High	NCCN Guidelines® for Cervical Cancer V.2.2025. Lorusso, Domenica et al. The Lancet, Volume 403, Issue 10434, 1341 - 1350
Adjuvant	cisplatin	Low	High	NCCN Guidelines® for Cervical Cancer V.1.2017. Moore DH, et al. J Clin Oncol. 2004;22(15):3113-9.
METASTATIC/RECURRENT
Initial Therapy	cisplatin + paclitaxel + pembrolizumab CPS ≥1	Low	Moderate	NCCN Guidelines® for Cervical Cancer V.1.2017. Colombo N et al. N Engl J Med 2021; 385:1856-1867
	carboplatin + paclitaxel + pembrolizumab CPS ≥1	Low	Moderate	NCCN Guidelines® for Cervical Cancer V.1.2017. Colombo N et al. N Engl J Med 2021; 385:1856-1867
	cisplatin, paclitaxel with or without bevacizumab	Intermediate	High	NCCN Guidelines® for Cervical Cancer V.4.2024 Tewari KS et al. N Engl J Med 2014;370:734-743. Tewari KS et al. Lancet . 2017 Oct 7;390(10103):1654-1663.
	carboplatin, paclitaxel with or without bevacizumab	Low	High	NCCN Guidelines® for Cervical Cancer V.4.2024 Tewari KS et al. N Engl J Med 2014;370:734-743. Tewari KS et al. Lancet . 2017 Oct 7;390(10103):1654-1663.
Subsequent Therapy	paclitaxel	Low	Low	NCCN Guidelines® for Cervical Cancer V.1.2017. Homesley HD, et al. Int J Clin Oncol. 2008;13(1):62-5.
	gemcitabine	Low	Low	NCCN Guidelines® for Cervical Cancer V.1.2017. Schilder RJ, et al. Gynecol Oncol. 2005;96(1):103-7. Schilder RJ, et al. Gynecol Oncol. 2000;76(2):204-7.
	cisplatin	Low	High	NCCN Guidelines® for Cervical Cancer V.1.2017. Moore DH, et al. J Clin Oncol. 2004;22(15):3113-9.
	carboplatin	Low	High	NCCN Guidelines® for Cervical Cancer V.1.2017. Weiss GR, et al. Gynecol. Oncol. 1990;39(3):332-6.
	cisplatin + paclitaxel + pembrolizumab CPS ≥1	Low	Moderate	NCCN Guidelines® for Cervical Cancer V.1.2017. Colombo N et al. N Engl J Med 2021; 385:1856-1867
	carboplatin + paclitaxel + pembrolizumab CPS ≥1	Low	Moderate	NCCN Guidelines® for Cervical Cancer V.1.2017. Colombo N et al. N Engl J Med 2021; 385:1856-1867
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.

EARLY (STAGE IA2-IB1); LOCALLY ADVANCED (STAGE 1B2-IVA) NON-METASTATIC

Chemoradiation

Evolent Pathways

cisplatin or carboplatin (if cisplatin intolerant)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and pembrolizumab *FIGO 2014 Stage III–IVA*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and pembrolizumab (if cisplatin intolerant) *FIGO 2014 Stage III–IVA*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Adjuvant

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

METASTATIC/RECURRENT

Initial Therapy

Evolent Pathways

cisplatin + paclitaxel + pembrolizumab *CPS ≥1*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

carboplatin + paclitaxel + pembrolizumab *CPS ≥1*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

cisplatin, paclitaxel with or without bevacizumab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin, paclitaxel with or without bevacizumab

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Subsequent Therapy

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

cisplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin + paclitaxel + pembrolizumab *CPS ≥1*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

carboplatin + paclitaxel + pembrolizumab *CPS ≥1*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent Therapy	albumin-bound paclitaxel (Abraxane)	Alternative: paclitaxel

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent Therapy

Regimen

** albumin-bound paclitaxel (Abraxane) **

Pathways and Low-Value Regimens

Cervical Cancer